Know Overdose: Inside San Francisco’s Overdose Prevention Campaign

Overdose fatalities and suicide are behind the longest decrease in life expectancy in the United States since World War I. In California’s Bay Area, the overdose death rate climbed by 21% between 2010 and 2019 and in San Francisco alone, at least 330 people succumbed to an overdose in 2019 based on recent data released by the city’s Department of Public Health. Many of the people we lost belong to communities pushed to the city’s bulging margins as a result of unprecedented gentrification and income inequality: people who are unhoused and living on the street. We urgently need bold solutions to end this crisis before an entire generation is lost to the overdose epidemic.

The Know Overdose campaign, led by the national Harm Reduction Coalition’s DOPE Project, is such a solution. It is a social marketing campaign led by and for people who use drugs that promotes practical and critical harm reduction messaging. The DOPE Project has fought at the front lines of overdose prevention for two decades. Its primary function is to provide the city’s harm reduction programs with naloxone, the lifesaving antidote to opioid overdose. Last year 2,601 overdoses were reversed with naloxone distributed by DOPE Project partner organizations. Imagine what the overdose rate might be without the program and without the work and love of the community we serve.

Yet, in the midst of one of the defining public health crises of our time, the San Francisco Department of Public Health (SFDPH) was forced by pressure from city Supervisors and members of the public to rescind its support for the community-led Know Overdose campaign. So we’re here to make a few things clear.

The Know Overdose campaign is built on three of the core principles of harm reduction:

1. The right and responsibility of people with a history of substance use to have a real voice in the creation of programs and policies designed to serve them.
2. Affirmation of the reality that people who use drugs are the primary agents of reducing the harms of their substance use, and therefore should be empowered to share information that reduces harms in the actual conditions of use.
3. Recognition of the structural violence that drives people further into society’s margins: poverty, class dynamics, social isolation, trauma, shame, discrimination, and racism.

The national Harm Reduction Coalition creates spaces for dialogue and action that help heal the harms caused by racialized drug policies.

This is our North Star Statement, a guiding compass that compels us to name racism as one of the driving forces behind mass incarceration, also known as modern-day slavery. We take this responsibility seriously, asking ourselves on a near daily basis, “How are we dismantling institutional racism?” We start from that question in the way we make decisions, in what and for or with whom we advocate, and in how we show up in community and demonstrate meaningful solidarity.

[Image Description] City street in San Francisco with a lit billboard that reads “Know Overdose” with an image of a man’s tattooed face.

We stand by the DOPE Project’s Know Overdose campaign because it was designed by and features members of the communities we come from and care about, many of whom are most impacted by the overdose epidemic, yet the least likely to be consulted about solutions. At best, these folks are disregarded. At worst, they are stereotyped as villains, lost souls, or as tropes to be ridiculed. These portrayals are especially hurtful when they come from people who have survived histories of structural violence and chauvinisms grounded in racism, sexism, and misogyny.

Our Executive Director, Monique Tula, told us yesterday, “As a black woman, born and raised in California, in a family of people who struggled with substance use, mental health, and poverty, I am deeply dismayed by the characterization of the people in these images as something we should be ashamed of. In particular, I am deeply concerned by the lack of nuanced understanding that black and brown people have been all but erased in the media’s portrayal of the ‘victims’ of the overdose epidemic.”

The images in the Know Overdose campaign are a reflection of just a few of those individuals who chose the way they wanted to be portrayed: powerful, resilient, and joyful.

To ignore their autonomy, desires, and pride erases their life-saving work, as well as their identities and experiences. The campaign shows a side of life that many of us have the luxury of ignoring, even as we step over people lying on the street. Their lives are as precious as their opinions are valid. Their voices matter, even if they hold a point of view that causes a visceral reaction. They still matter.

[Image Description] “These posters make us feel like this city has not forgotten us. That San Francisco does care about all its inhabitants. The images offer us a critical and essential message to those of us who find ourselves at risk in this epidemic, either with our own lives or the lives of our loved ones, that this complicated and unrelenting struggle does not have to be a lonely one.” — Miss Ian, Executive Director, SFDUU

We cannot rise to the challenge of the overdose epidemic without clear and candid messages for people most at risk, and we cannot end the overdose crisis in San Francisco until we Know Overdose. San Franciscans need to know that our collective efforts to confront overdose by going directly to people who use drugs have already saved countless lives, and we face new challenges that require new strategies. When we Know Overdose, we’re equipped to spread the awareness and education that our communities need to keep each other safe and save lives.

Learn more and take action:

• Get more insight on the campaign’s methodology and view all ads here
• Tweet this thread to support the campaign
• Follow @DOPEproject and @HarmReduction on Twitter to stay connected